Travel Medicine News

• Report from the Asia Pacific Conference on Travel Health
• Report about WHO publication "International Travel and Health"

Report from the Asia Pacific Conference on Travel Health, Bali, Indonesia, July 21-23, 2000

Travel Medicine in the Developing World

"In the 21^st century, developing countries will have to provide health services for travelers that are commensurate with their five-star hotels in order to maintain thriving tourist industries," said the Indonesian Ministers of Health and Tourism at the 3^rd meeting of the Asia Pacific Conference on Travel Health held in Bali, Indonesia, July 21-23, 2000. The previous two meetings were held in Hong Kong and Taipei.

Several speakers from Indonesia proposed that their government improve healthcare for visitors by establishing offices for tourist health at either the federal or provincial government level and/or establishing licensing and accreditation systems for those providing the services. Although somewhat controversial, many international experts believe that using government resources, even in poor countries, to improve the health care of tourists - even while most local people receive only rudimentary healthcare - is an important basic step in improving the health infrastructure for the entire population. Basic goals are dependable electricity, clean water, sanitary food handling, and proper sewage disposal. (In recent years, officials in Jamaica and Tunisia, for example, asked international experts to investigate unusually high incidences of travelers’ diarrhea in these countries. The recommendations of the experts were implemented and the incidence of travelers’ diarrhea decreased, helping tourism, and also helping these countries to improve all of their sanitary services, and helping their economies.)

However, other speakers pointed out the fact that in developing countries tourist dollars also bring problems. For example, the news – or just a rumor – that a large, luxury hotel is to be built and that there will be a need for hundreds of employees, brings many times that number of job seekers to the area. Most of the job seekers are men, and they often come from great distances. Many fail to secure jobs, stay on, and leave families behind. This creates shantytowns and causes crime and disease rates to soar. In many parts of the world the combination of tourism and local socioeconomic problems have played important roles in introducing and spreading HIV infections, for example (see below).

Today, in developing countries, the discipline of travel medicine is either in its infancy or non-existent. (The Indonesian Travel Health Society was founded in 1997, for example.) If early signs prove correct, in such countries, practitioners of travel medicine will have two important functions: caring for visitors who become ill or are injured; and, as in the developed world, preparing local people for going overseas, often to other developing countries.

The fees from visitors will be an important impetus for local physicians to modernize their clinics and to attend continuing education courses, overseas if necessary. Without such fees, overseas travel may be prohibitively expensive. And more people from developing countries are traveling internationally. For example, more than a million Indonesians already do so annually, with a large percentage of them going on pilgrimages to Saudi Arabia.

The ideal approach for keeping travelers healthy in developing countries, especially long-term travelers and expatriates, is two-pronged: travelers receive pre-travel immunizations and preventative medications from a travel medicine specialist in their home country, and then receive on-site, preventative and on-going health counseling from a travel medicine specialist in the host country, says Santanu Chatterjii, MD, consultant physician in Travel and Tropical Medicine at the Wellesley Medicentre Calcutta, India. Ideally, the two specialists should work closely together, with the host country specialist stocking the same vaccines and completing immunization series schedules that were not completed before departure, for example. Host country physicians are in a better position to be familiar with local health risks and disease transmission patterns such as local allergens, insect precautions, and safe transport options, for example. And they can secure proper medications and arrange for consultation with other medical specialists, as well as hospitalization and evacuation, if necessary. Importantly, host country travel medicine specialists also tend to be familiar with cross-cultural adaptations and can help long-term travelers and expatriates deal with stress problems.

Names of travel medicine specialists in various countries are available from the directory of the International Society of Travel Medicine.

Members will be able to judge the caliber of colleagues by "word of mouth," contacts at meetings, and by certification. Formal testing and other standards for the field are becoming more common.

A special event was held one day before the Conference, A Basic Course on Travel Medicine. Travel Medicine is a relatively new subject in Indonesia. This was the first course of its kind held in Indonesia. The aim: to help physicians new to the field to improve their basic knowledge and skills in providing health care for tourists. A short introduction was given by Professor Robert Steffen, a founder and former president of the International Society of Travel Medicine. Topics covered included How to Set Up a Travel Clinic, Impact of the Environment, Impact on the Host Country, Travel Advice, Travelers' Diarrhea, Evacuation Procedure, Immunization and Vaccines. About 150 physicians participated. The course proved so successful that the Indonesian Travel Health Society (ITHS) is planning annual courses.

APTHS Business Meeting: All country representatives agreed to re-establish the Asia Pacific Travel Health Society (APTHS) which will be the new name of APTH and consists of all countries within the Asia-Pacific Region supported by the International Society of Travel Medicine (ISTM).

The meeting elected the first executive board of APTHS:

• President: Prof. Dr. Yahya Kisyanto, Indonesia
• President Elect: Dr. Nor S. Kairullah, Malaysia
• Secretary General: Dr. Hanny G. Moniaga, Indonesia
• Treasurer: Dr. Robert Kass, Australia

The presidency term will run for two years; after this period, the President Elect will automatically be the new President and the former President will become the Past President.

The permanent office will be in Jakarta, Indonesia. The office will be run by the Secretary General who will work closely with the Treasurer. Their terms will run for 6 years.

APTHS has also elected counselors: One of their duties will be to set and maintain high scientific and professional standards for the Society.

The Counselors elected are:

• Eli Schwartz (Israel)
• Santanu Chaterjee (India)
• Mikio Kimura (Japan)
• Xu Hua (People Republic of China)
• Abu S.M. Abdullah (Hongkong-People Republic of China)

The Society has selected Shanghai, China to be host of the 4^th APTHS Conference in October, 2002, and Australia for the 5^th APTHS Conference in 2004.

Some of the travel health news from the conference:

The malaria situation in Indonesia continues to deteriorate with more cases each year than the year before. The latest estimation is more than 6 million cases and about 700 deaths, with the disease appearing in areas where malaria has not been seen in decades. The reasons for the growing problems are population movements, environmental changes, drug resistance, and lack of trained personnel at the village level to perform the necessary preventative, diagnostic, and treatment functions.

The HIV/AIDS situation in China is deteriorating, the result of more international travel to and from the country, and internal migration. The number of cases is officially said to be 17,000 but the true number is probably more than 500,000. There were also large increases in drug traffiking with at least 600,000 addicted to illegal drugs, more than 4 million prostitutes, and increase in mobile population including 120 million migrant workers.

Tuberculosis is an old disease that should be keep in mind. In Indonesia, the incidence is rising annually and is now considered the most serious health challenge, with 450,000 new cases a year and 175,000 deaths. Much of the disease is multi-drug resistant. Travelers planning to spend prolonged time in the country, especially those who will have close contact with local people should have Mantoux skin tests before travel and upon returning home.

Please Consider Joining APTHS

Obtain registration form at:

APTHS Secretariat:
Phone: 62-21-453 2202, 325 353
Fax: 62-21-453 5833, 314 4614
E-mail: hmoniaga@indo.net.id, kisjanto@dnet.net.id

The annual membership is only US $6.00. Please fill in the form with capital letters and return it to the Secretariat.

Report about WHO publication "International Travel and Health"

WHO is undertaking an in-depth revision of the publication "International Travel and Health" to take into account the changing trends in international travel and new health risks for travelers. The upcoming version will aim to meet the needs of all types of travelers as well as their health advisers. The information will be presented in a practical, readily accessible format and style. There are also plans to develop a web version in parallel with the book. The new version of the book is expected be published early in 2002. The revision will be made on the basis of widespread consultation with travel medicine experts and with all the people who presently consult "International Travel and Health." Members of the International Society of Travel Medicine are invited to submit comments and suggestions to WHO. The project is being coordinated by Dr. Lindsay Martinez, who can be contacted by e-mail at: martinezl@who.int.